Evaluation of patient compliance with the use of scrotal cooling devices

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VOLUME 2, ISSUE 3, P289-295, SEPTEMBER 01, 2021


Tarik Benidir, M.D., Taylor Remondini, M.D., Susan Lau, B.Sc., Keith A. Jarvi, M.D. 



To evaluate the compliance of infertile men with the use of scrotal cooling devices. As a secondary objective, sperm parameters, deoxyribonucleic acid fragmentation, and hormone profiles were examined.


This exploratory study on scrotal cooling provided scrotal cooling devices to men with primary infertility and abnormal semen parameters. Feedback on the devices after their use was gathered in the form of a questionnaire, and semen parameters were examined after device use.


Single center infertility clinic in Toronto, Ontario, Canada.


Patients with primary infertility and abnormal semen parameters were prospectively evaluated before and after scrotal cooling.


One of two scrotal cooling devices (Underdog or Snowballs) was used, on the basis of patient preference.

Main Outcome Measure(s)

Questionnaires were completed by patients on compliance with device use and concerns about and recommendations for improving the cooling devices. Baseline deoxyribonucleic acid fragmentation index, sperm parameters, and hormones were measured at the initial visit (t = 0) and at subsequent visits (t = 4–12 weeks). Statistical comparison of values before and after scrotal cooling was performed.


Forty patients were enrolled in the study, and the questionnaire was completed by 65.0% (n = 26). Most respondents (76.9%) used scrotal cooling less than the recommended duration. Respondents believed that the devices were uncomfortable (31.5%), impeded work (21.0%), and lost cooling rapidly (14.3%). Significant increases in sperm motility and vitality (from 25.4 % to 29.0% and from 64.8% to 71.7%, respectively) were demonstrated after scrotal cooling.


Most patients were not compliant with the recommended use of the scrotal cooling devices because of issues of comfort, convenience, and concealability. Further work on improving scrotal cooling devices is necessary to enhance their potential as a therapeutic tool for men with abnormal sperm parameters and infertility.